Provider Demographics
NPI:1063439610
Name:GRANDE, EDGARDO ARTURO (DMD)
Entity type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:ARTURO
Last Name:GRANDE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 ROYAL POINCIANA WAY
Mailing Address - Street 2:SUITE 309
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-4048
Mailing Address - Country:US
Mailing Address - Phone:561-832-6647
Mailing Address - Fax:561-832-6828
Practice Address - Street 1:340 ROYAL POINCIANA WAY
Practice Address - Street 2:SUITE 309
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-4048
Practice Address - Country:US
Practice Address - Phone:561-832-6647
Practice Address - Fax:561-832-6828
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 162471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 16247OtherSTATE DENTAL LICENSE
BG7105871OtherFEDERAL DEA NUMBER